Colin Hoobler: Exercise not only allowed, it's vital during pregnancy

Dear Colin: I'm 24 years old and just learned that I'm eight weeks pregnant. While I'm excited about having a baby, I'm concerned about causing problems if I keep exercising as I have been. My obstetrician tells me that walking is enough, but I'm used to doing more than that. What's the typical exercise recommendation for expectant mothers who are used to being active? -- Vanessa F.

Most obstetricians I know typically prescribe physical therapy for expecting patients (given that most suffer from back pain), so insurance covers costs associated with getting a safe exercise program. Your obstetrician seems far too conservative compared to current trends in prenatal exercise, which is not just being allowed in normal pregnancies, but actively encouraged.

In fact, the Society of Obstetricians and Gynecologists of Canada has stated that failure to exercise during pregnancy may be associated with certain health risks. "As we gain more insight and move forward, we will probably become more and more liberal with respect to exercise recommendations for pregnant women," says Dr. Gregory A.L. Davies, chief of maternal-fetal medicine at Queen's University. "If you're pregnant and not exercising, you need to start, and this message has never been said before."

Research is mounting that expecting mothers may unnecessarily expose themselves to serious health risks by not engaging in regular exercise. These risks include excessive body fat gain, increased risk of gestational diabetes, pregnancy-induced hypertension, development of varicose veins and low back pain (Journal of Obstetrics and Gynaecology Canada 2003; Obstetrics & Gynecology 2002). In addition, you may be at greater risk for post-partum depression, which can be extremely difficult and costly to treat (the primary treatment for post-partum depression includes exercise, anyway!).

Here are my recommendations for all pregnant women: Engage in moderate-intensity strength training three-to-four times a week (Pilates and/or yoga are adjunctive, not substitutive). The goal should be achieving/maintaining basic fitness levels in strength, body fat level, endurance and flexibility as opposed to intensive training. Selected activities should be low-risk for falling and/or fetal trauma. After birth, pelvic floor exercises should be initiated immediately to lower risk of incontinence.

All obstetricians should encourage their pregnant patients to start or continue exercise regimens not only to make for an easier labor, but also to combat obesity and other potential diseases in the mother and child. Being obese also makes it more difficult to assess fetal health via ultrasound, increasing the risk of cesarean section.

Exercise recommendations for the frequency, duration and intensity of exercise are actually similar to those for women who aren't pregnant, but the emphasis is "moderate" intensity during activities. In other words, you should always feel like you can talk during exercise, but not sing. This should keep your heart rate at or below 140 beats per minute, the consensus for pre-natal exercise intensity (American College of Obstetricians and Gynecologists 2005).

As an expectant mother, you obviously want what's best for you and your baby. Now more than ever, that means ditching the excuses and moving for the sake of two important people.

Colin Hoobler is a freelance writer who practices physical therapy at c.h. Physical Therapy (chpt.org) and teaches exercise medicine at OHSU. His "Move in the Right Direction" health segment airs between 8:15 and 8:30 a.m. most Saturdays or Sundays on KGW(8). Send questions tocolin@chpt.org